When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Wednesday, February 20, 2013

Maybe an affirmation from God's heart
Getting scolded and rebuffed
For standing in the stead of the helpless and their helpers.

"It was inappropriate."
And so it was! But only from the rarefied roost
of the elite guardians of The Image
Anything for The Image.

But from the humbler, simpler stance
of the helpless and their helpers
The voice that rises to raise the right questions
is always the right remedy for the right malady
Always the empathic hand that removes the thorn
from the festering paw.

What's the difference?
It's in the direction.
The self-absorbed and self-promoters
Live on a one-way street of Thou shalt give to me
But those whose eyes take in the needs of others
Find their truth in serving.

So maybe it was a compliment
to be summoned by the court
A backhanded affirmation from the Lowly and their Liege
The Rulers think they won!
But when the world is turned upside down,
The spurned, who fell, are rising.

Saturday, February 16, 2013

Your coworker spoke deep truth on changes in IDT at Generic Hospice. I offer a bit of same (hopefully) in return regarding Gentiva. I intersperse my lament with words from Gentiva CEO Tony Strange:

I can't say I was excited about the way Gentiva leaders decimated our hospice's clinical services. Over a period of months they instituted programs that eliminated every special, distinctive, unique thing we
did for our patients. Gentiva corporate dismantled what made us the standard of excellence in our community.

"We have four pillars for growth. One, we continue to invest in our clinical delivery system... Two, continue to expand our referral base through investment in our sales organization...Three, realize Home Health/Hospice synergies (Positioning Gentiva to be a care transition company, to get patients into the most cost effective setting)…. Four, grow through strategic acquisitions (Positioning ourselves,looking to de-lever by paying down debt/growing earnings, look at opportunistic acquisitions)."--Tony Strange, Gentiva CEO at 2013 JP Morgan Healthcare Conference.

I saw earnings grow through employee turnover. It bothered me that many of my peers worked long hours covering for two positions for months at a time and the company did nothing to thank them, much less reward them for their burdensome labor. They were salaried. There was no additional compensation. My peers worked the hours needed "to get the job done." It mattered not to the higher ups that one person was doing two jobs. That bolstered EBDITA.

When someone does two jobs they can't do both well. When mistakes were made, as any competent leader could predict, management hammered them. Write ups, counselings, what's the matter with you, why can't you think, I'll teach you, now get back to work and stay until everything's done to my specific direction! While it may have been couched in more socially appropriate wording, the message was clear.

Things weren't great, but I maintained my intrinsic motivation to help others do sacred work, that is until....

"We have a very strong density in Certificate of Need states, which creates a barrier to entry. We have a very strong presence in CON states."--Tony Strange, Gentiva CEO

...they judged me. I could expound on technical flaws regarding the annual performance evaluation, how it wasn't based on my job description, how it covered events after the evaluation period or how I was held accountable for things not within my control. Those bothered me, but something cut deeper.

Gentiva rammed a stake through my intrinsic desire to do good work, to be part of a team, to
contribute to something greater, something sacred. I let their judgment pierce my heart.

I swore I wouldn't let in those corporate bastards. I promised to hold off their reliance on word-parsing lawyers, tight-fisted bean counters, and orange-tinted, white-toothed marketers. This troika set the corporate agenda which repeatedly unbalanced our site. Even with our hospice badly listing, I thought I could hold on, hang in there, even be a positive, counterbalancing force.

"Average aged of our patient is 79 years old. They have multiple co-morbid diagnoses and are on 10 or more medications."--Tony Strange, Gentiva CEO

We used to deliver medications to the patient's home. The company instituted a new formulary which dropped many medications our patients
used. Overtime was banned, needing corporate approval before a nurse or chaplain could stay over.

At first, staff ignored corporate directives. When a nurse asked to stay with a dying patient, the common answer, "No Overtime allowed." Nurses, given their professional oath, usually donated their time.

When corporate HR learned this, a pinhead essentially said, "That's not allowed. They can't work overtime without approval and they can't donate their time. Write 'em up. Who's doing it?"

No one answered.

Pinhead,"Warn them, if they do it again they'll be fired!"

"Investment highlights. Demographics are compelling. Our market grows by 10,000 people per day. Patients have skin in the game. We have a seasoned management team. Most of the team have been with me
over a decade."--Tony Strange, Gentiva CEO

This "management team" knows Home Health. They don't know jack squat about Hospice.

How did I allow this crappy company, with its over-reliance on control by extrinsic motivation, to wound my internal desire to make a difference? I struggled with how to move forward ever since I was labeled a "good,
solid employee," nothing special.

Funny, the descriptions in the evaluation were highly complimentary. They noted the many outstanding things I'd accomplished. If those words were the only thing on the page, I'd have been content. No, the company had to collapse me into a summary rating (High, Medium or Low).

They ranked me M for mediocre, effectively damning me with faint praise. They collapsed a year's worth of hard work,where I'd done many things outside my job description, into one solitary letter
of the alphabet. It seemed I was downgraded for not doing even more outside my job, despite putting in long hours, with great impact.

The evaluation came with nothing. I received no raise, no bonus, no gift card, no anniversary present, not even a cheap Chinese pen or crappy mouse pad embossed with the company logo.

I felt I gave my all. I didn't see how I could've worked harder or been more effective. I would've been happy to not had their judgment, pro or con.That's not why I do the work.

Yet, they gave it and I made the mistake of listening. Gentiva's judgment acted like an invasive cancer on my heart. It couldn't see a sliver of what I'd contributed, much less the whole. I had to remind my evaluator of the many things I'd done specifically to help them and our site, most of which were not in my job description. What the company couldn't see, it couldn't appreciate.

I did those things because I wanted to, not for recognition. So why is this bothering me so much now? Why would I expect an out of balance company to appreciate human respect and dignity? Maybe I don't want to
become mediocre, like the company itself.

"Closed or sold about 59 locations... Took a lot of cost actions end of last year, took out additional regional/area costs, corporate back office costs... Home health continues to run very strong... Hospice has been challenged... Get after growth with sales initiatives, better trained sales people, more salespeople, more feet on the ground. Put a new leader in April in Hospice sales organization. No different than what we went through with home health two years ago. Looking forward to 2013 and getting hospice back on track." Eric Stusser, Gentiva CFO at 2013 JP Morgan Healthcare Conference

Anonymous

Addendum: It's been two years and the second evaluation went much like the first. While my co-workers say they've never had service this good, my boss focused on a handful of things I hadn't done. It's sad when the annual evaluation requires a coat of armor to survive. Toxic management is alive and unwell at Gentiva.

Among the changes experienced in hospice philosophy in recent years, as hospice work increasingly come under the influence of corporate business and its marketing emphasis, is the change in image of the interdisciplinary team meeting, or IDT. In former times, the IDT meeting was something like a blue collar Laundromat. Yes, it was professional, organized and to the point. But there was an understanding that each person was bringing in some dirty laundry, and that it would be sorted out, thrown into the washing machines, and that this would involve some noise, some agitation, some movement and chaos, on the way to ending up with clean, dried, and folded items, ready for the next day's jobs. The way the soiled clothing arrived and the way the finished product ended up, presumed and welcomed a sometimes rough and tumble process in between.In more recent times, and increasingly, there are different forces at work, and an image that might express the change in IDT is that of the finale of a Beauty Pageant. The unspoken but strongly implied expectation is that there is to be a show of excellence and shiny perfection. The attractive and beautiful surfaces are paraded upon the stage, for all to ooh and ahh. There is niceness and tidiness from start to finish. There is a hyper-awareness that the cameras are rolling. We smile, but with measured propriety. Our lines are pre-censored, and well rehearsed. No ad lib comments will be tolerated. No embarrassing or uncomfortable questions are to be asked. It's not an earthy process--it's a careful performance. Contradictory opinions and al challenges will be viewed as crass rebellion, and as undermining the status quo, which is believed to be have been dropped down whole from Corporate heaven.Beautiful surfaces look impressive. But I miss the realness, liveliness, and outcomes of the old washateria.

Saturday, February 9, 2013

The real Tony Strange commented on Gentiva's 4th quarter and 2012 financials. Financial analysts seemed impressed the company has a new Executive Chairman. Rod Windley. Strange stated Windley already sat on the board but will go from working 20% of his time on behalf of Gentiva to working 100%. Windley made roughly $250,000 in board compensation working part time. Turning that pay rate into full time means over $1 million in compensation. That's a new $750,000 of corporate overhead.

Analysts also noted Gentiva's cash position of $200 million. They wondered what management planned to do with these resources. Here's what the company won't do:

Company policy does NOT allow Gentiva to provide scrubs for employees at this time.

Company policy does NOT allow Gentiva employees to receive a raise.

Company policy does NOT enable clinical employees to be fully reimbursed for their mileage driven or be paid the full federal mileage rate.

Company policy does NOT allow for company paid Christmas parties

Company policy does NOT allow for wages to remain competitive or for scales to hold integrity over time. Company policy does NOT allow for employees to share their voice via a company-wide employee survey.Company policy does NOT allow for employees to share their ethical concerns in a confidential manner via telephone.

One thing's for sure. Gentiva won't put the $200 million into its employees. However it did put $5 million into buying back stock during the first three quarters of 2012.

Tuesday, February 5, 2013

You speak a language unfamiliar to me, that of business. Nevertheless, I am grateful for the things you pointed out regarding the shallowness of your company. It's been a difficult week at Generic Hospice, only two days in and it feels like thirty.

Our local site leader has been on a tear. People worked hard while this person was away, some business, some travel. Several compelling hospice stories occurred in their absence. This seemed to refuel the tanks of our team, regularly depleted by seemingly arbitrary corporate and local dictum(s).

However, our local leader was unable to appreciate the incredible team work displayed while they were gone. Their first staff meeting back was a scolding. A scolding, when it should've been a pat on the back, a hearty laugh and a round of ale (ginger) for toasting. My take? If they weren't here to make it right, it had to be wrong. Complete morale killer.

There is no one to tell. Corporate goons regularly play "good cop/bad cop" on us. They show up saying, "Tell us what's wrong, we want to hear it." Halfway through spilling our beans, the bad cop comes up behind and slams our face into the table. Bam! "Sucker! You think we care about your crybaby asses."

So we're alone, watching a severely damaged person wreak havoc, repeatedly. Turnover is 50% since I joined the company. They sell it as 12%.

I am told I work for an exemplary leader. I believe this person is outstandingly destructive and manipulative. This leader picks several victims at a time. Over a period of months, this leader targets, torments and emotionally tortures their victims. Most quit. A few have been fired and escorted out.

There is never a period when the list has no targets. Staff fear their name will rise to the top. A pattern exists, one which Generic Hospice corporate cannot see. If they cared then they might've done an employee survey the last two years. .

Our site has the best hospice doctors in town and no nurses want to work for us. They know what corporate can't figure out, our local leader is toxic. It makes me think corporate leaders are like ours, concerned about image, surface items, and whatever is needed in the moment to make them look good.

Orange-skinned, white-toothed marketing people produce binders about selling, without one mention of a hospice heart. Corporate people talk about "sales strategy" and "game plan," but they fail to recognize the importance of relationships in a community. They berate staff with "Close hard," cajole us with "Way to go", as if staff would not do a good job without their summary comment/evaluation.

Our site ran better with our manager away and no corporate visitors. That's a sad commentary, when "leadership" causes more harm. Thanks for listening,

Saturday, February 2, 2013

Thought you might want to share two items related to Gentiva's dealings with the investor community. The first is the way Gentiva represented their giant stock price fall on their website. At one point the stock was over $30. It fell below $5. Note the difference between the Yahoo Finance chart (Blue) and the onetime Gentiva chart (maroon).

Compare the space from $0 to $10 to the space from $20 to $30, each being an increment of 10. Gentiva's website now shows an accurate chart for their stock price.

The second item relates to Gentiva's annual report filed with the SEC. Gentiva scanned a paper document for submission, thus the black and white image above. The annual report downloadable from the company's website is a color PDF document. GTIV's SEC document is not searchable, the PDF can be searched. While Gentiva is not alone in sending less usable documents to the SEC, the company did go to extra trouble to do so..

Both items say something about Gentiva's corporate culture and neither are encouraging..